Medical Knowledge Competency Research Articles

Ten Steps for a Successful Hand Surgery Mission Trip - Experiences from Supporting Paediatric Hand in Vietnam and Honduras.

Domestic and global access to surgical care for paediatric hand and upper limb conditions is challenged by limited resources, increasing direct and indirect costs of care and a growing number of patients who require specialty care. There are numerous barriers for patients from developing countries to receiving medical care in Japan due to the substantial costs, which include travel, uninsured medical expenses and fees imposed by intermediaries. To address this issue, I realised that I needed to take a more direct approach - by travelling to these countries, not only to provide treatment, but also to teach and train local doctors. By emphasising on the education of local clinicians through the sharing of knowledge and skills, it is possible to expand the timely access to paediatric hand surgery and improve outcomes for children in need. Our mission is rooted in the belief that every nation holds its own unique treasures - its culture, food, beauty and joy - that are worth celebrating and preserving. By fostering sustainable relationships built on mutual respect and understanding, we can make a greater impact; engagement with local surgeons will ultimately elevate the level of care that they can provide in their own communities, through improving core competencies of medical knowledge, technical/surgical skills and resource allocation for simple and complex conditions. This work not only reflects my personal commitment, but also my focus on expanding our team of fellows and strengthening organisational support. We aim to actively pursue these efforts throughout Asia, fostering cross-cultural collaboration and, ultimately, helping to heal the hands and futures of children worldwide. The aim of this review article is to share with readers how we started our mission trips to Vietnam and highlight 10 steps that I feel are critical to a successful mission trip.

Fostering Trust in Public Health Messaging: Tailoring Communication for Rural Parents.

As pandemic-related mistrust of public health recommendations in rural communities may compound gaps in pediatric immunizations, our team explored parents' perceptions of trustworthiness in messaging. Qualitative study using 4 virtual focus groups. Rural Wisconsin. Participants (n = 25) were parents or guardians of children recruited through our contacts with community-based organizations serving rural communities. Researchers used task-oriented elicitation techniques to initiate discussion on the trustworthiness of messengers and messages providing health recommendations. Participants were asked to (1) review existing public health messaging on a range of topics and from a range of sponsors; and (2) rank a list of potential messengers in terms of trustworthiness (eg, local health department, Centers for Disease Control). Discussions were recorded, and audio files transcribed, to facilitate a team-based, thematic analysis. Competency in medical knowledge and parenting experience contributed to estimations of trustworthiness. Participants also responded well to messages and messengers that were able to project recognition of their children's uniqueness and their experience as parents. Participants distrusted messengers who were seen as biased or "one-sided" in their perspectives. For successful health promotion for rural-living parents, messengers must be recognized as "competent" to provide pediatric health advice and to avoid blanket recommendations that may undermine parents' experience and feelings of being "understood" and affect perceptions of trustworthiness.

Can USMLE and COMLEX-USA Scores Predict At-Risk Emergency Medicine Residents' Performance on In-Training Examinations?

The United States Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores are standard methods used to determine residency candidates' medical knowledge. The authors were interested in using the USMLE and COMLEX part 2 scores in our emergency medicine (EM) residency program to identify at-risk residents who may have difficulty on the in-training exam (ITE) and to determine the cutoff values under which an intern could be given an individualized study plan to ensure medical knowledge competency. The authors abstracted the USMLE and COMLEX part 2 scores and the American Board of Emergency Medicine (ABEM) ITE scores for a cohort of first-year EM residents graduating years 2010-2022, converting raw scores to percentiles, and compared part 2 and ABEM ITE scores with Pearson's correlation, a Bland-Altman analysis of bias and 95% limits of agreement, and ROC analysis to determine optimal the cut-off values for predicting ABEM ITE < 50th percentile and the estimated test characteristics. Scores were available for 152 residents, including 93 USMLE and 88 COMLEX exams. The correlations between part 2 scores and ABEM ITE were r = 0.36 (95%CI: 0.17, 0.52; p < 0.001) for USMLE and r = 0.50 (95%CI: 0.33, 0.64; p < 0.001) for COMLEX. Bias and limits of agreement for both part 2 scores were -14 ±63% for USMLE and 13 ± 50% for COMLEX in predicting the ABEM ITE scores. USMLE < 37th percentile and COMLEX < 53rd percentile identified 42% (N = 39) and 27% (N = 24) of EM residents, respectively, as at risk, with a sensitivity of 61% and 49% and specificity of 71% and 92%, respectively. USMLE and COMLEX part 2 scores have a very limited role in identifying those at risk of low ITE performance, suggesting that other factors should be considered to identify interns in need of medical knowledge remediation.

ChatGPT's performance in German OB/GYN exams - paving the way for AI-enhanced medical education and clinical practice.

Chat Generative Pre-Trained Transformer (ChatGPT) is an artificial learning and large language model tool developed by OpenAI in 2022. It utilizes deep learning algorithms to process natural language and generate responses, which renders it suitable for conversational interfaces. ChatGPT's potential to transform medical education and clinical practice is currently being explored, but its capabilities and limitations in this domain remain incompletely investigated. The present study aimed to assess ChatGPT's performance in medical knowledge competency for problem assessment in obstetrics and gynecology (OB/GYN). Two datasets were established for analysis: questions (1) from OB/GYN course exams at a German university hospital and (2) from the German medical state licensing exams. In order to assess ChatGPT's performance, questions were entered into the chat interface, and responses were documented. A quantitative analysis compared ChatGPT's accuracy with that of medical students for different levels of difficulty and types of questions. Additionally, a qualitative analysis assessed the quality of ChatGPT's responses regarding ease of understanding, conciseness, accuracy, completeness, and relevance. Non-obvious insights generated by ChatGPT were evaluated, and a density index of insights was established in order to quantify the tool's ability to provide students with relevant and concise medical knowledge. ChatGPT demonstrated consistent and comparable performance across both datasets. It provided correct responses at a rate comparable with that of medical students, thereby indicating its ability to handle a diverse spectrum of questions ranging from general knowledge to complex clinical case presentations. The tool's accuracy was partly affected by question difficulty in the medical state exam dataset. Our qualitative assessment revealed that ChatGPT provided mostly accurate, complete, and relevant answers. ChatGPT additionally provided many non-obvious insights, especially in correctly answered questions, which indicates its potential for enhancing autonomous medical learning. ChatGPT has promise as a supplementary tool in medical education and clinical practice. Its ability to provide accurate and insightful responses showcases its adaptability to complex clinical scenarios. As AI technologies continue to evolve, ChatGPT and similar tools may contribute to more efficient and personalized learning experiences and assistance for health care providers.

A Pilot Standardized Simulation-Based Mechanical Ventilation Curriculum Targeting Pulmonary and Critical Care Medicine and Critical Care Medicine Fellows.

Introduction The mastery of mechanical ventilation (MV) management is challenging, as it requires the integration of physiological and technological knowledge with critical thinking. Our aim was to create a standardized curriculum with assessment tools based on evidence-based practices to identify the skill deficit and improve knowledge in MV management. Methods For 3 years, 3 hours of standardized curriculum for each first-year pulmonary critical care medicine (PCCM) and critical care medicine (CCM) fellows was integrated into the orientation (chronologically): (1) a baseline knowledge pretest; (2) a 1-hour one-on-one case-based simulation session with debriefing. A 34-item competency checklist was used to assess critically thinking and skills and guide the debriefing; (3) a 1-hour group didactic on respiratory mechanics and physiology; (4) a 45-minute hands-on session in small groups of one to three fellows for basic knobology, waveforms, and various modes of mechanical ventilators; (5) a 15-minute group bedside teaching of vented patients covering topics such as techniques to alleviate dyssynchrony and advanced ventilator modes; (6) a one-on-one simulation reassessment session; (7) a knowledge posttest. Fellows' performances at baseline, 1-month posttest, and end-of-first year post-test were compared. Results Fellows ( n = 24) demonstrated significant improvement at 1-month posttest in knowledge (54.2% ± 11.0 vs. 76.6 ± 11.7%, p < 0.001) and MV competency (40.7 ± 11.0% vs. 69.7 ± 9.3%, p < 0.001), compared with pretest. These improvements were retained at the end-of-year reassessments (knowledge 75.1 ± 14.5% and MV competency 85.5 ± 8.7%; p < 0.001). Conclusion Standardized simulation-based MV curriculum may improve the medical knowledge competency, and confidence of first-year PCCM and CCM fellows toward MV management before encountering actual ventilated patients.

The Impact of Post-graduate Year and Program Accreditation Status on In-Training Examination Performance in Orthopaedic Surgery.

Introduction The progression of medical knowledge competency during surgical residency training is poorly understood. This study measures the acquisition of medical knowledge as orthopedic surgery residents advance during training and the impact of accreditation status on orthopedic in-training examination (OITE) performance. Methods Orthopedic surgery residents taking the OITE during 2020 and 2021 were included. Residents were grouped into cohorts by post-graduate year (PGY) and Accreditation Council for Graduate Medical Education (ACGME) accreditation status. Comparisons were made with parametric tests. Results Eight thousand eight hundred and seventy-one ACGME-accredited residents (89%) and 1,057 non-ACGME-accredited residents (11%) were evenly distributed by the PGY level (range, 19-21%). Residents in both ACGME- and non-ACGME-accredited residency programs had a significant increase in OITE performance at each PGY level (P<0.001). At ACGME-accredited programs, OITE performance increased from PGY1 (51%), PGY2 (59%), PGY3 (65%), PGY4 (68%), and PGY5 (70%) (P<0.001). There were progressively smaller percentage increases in OITE performance during accredited residency training (range, 2-8%), but this increase was linear in non-accredited residency training (range, 4%). At each PGY level, residents at accredited programs outperformed their counterparts at non-accredited programs (P<0.001). Conclusion OITE performance increases during residency training. Among ACGME-accredited residents, performance on the OITE progresses rapidly during junior years and plateaus during senior years. Residents in ACGME-accredited residency programs outperform their counterparts in non-accredited residency programs. More research is needed to understand optimal training environments that promote medical knowledge acquisition during orthopedic surgery residency.

A new era of assessment for neonatal-perinatal medicine trainees: milestones 2.0.

To optimize post-graduate competency-based assessment for medical trainees, the Accreditation Council for Graduate Medical Education initiated a sub-specialty-specific revision of the existing Milestones 1.0 assessment framework in 2016. This effort was intended to increase both the effectiveness and accessibility of the assessment tools by incorporating specialty-specific performance expectations for medical knowledge and patient care competencies; decreasing item length and complexity; minimizing inconsistencies across specialties through the development of common "harmonized" milestones; and providing supplemental materials, including examples of expected behaviors at each developmental level, suggested assessment strategies, and relevant resources. This manuscript describes the efforts of the Neonatal-Perinatal Medicine Milestones 2.0 Working Group, outlines the overall intent of Milestones 2.0, compares the novel Milestones to the original version, and details the materials contained in the novel supplemental guide. This new tool should enhance NPM fellow assessment and professional development while maintaining consistent performance expectations across specialties.

Assessment Briefs

Assessment Briefs

Abstract 13846: Shared Curriculum Delivery Gaps Among Advanced Heart Failure and Transplant Cardiology Fellowship Programs

Introduction: Nearly 4,000 heart transplants and more than 5,000 LVAD implants were performed in the US in 2021. Medical care for these patients is performed by Advanced Heart Failure and Transplant Cardiology (AHFTC) physicians. Variations in faculty expertise and patient pathology exist between training programs, and some may be unable to provide a curriculum addressing all recommended competencies during the one-year-long fellowship. This study is a targeted needs assessment identifying gaps in curriculum delivery among US AHFTC fellowship programs. Methods: 50 medical knowledge competencies were selected from the 2017 ACC/AHA/HFSA/ISHLT/ACP Training Statement on Advanced Heart Failure and Transplant Cardiology. AHFTC fellowship programs were identified using the AMA’s FREIDA website. A survey was published on Qualtrics. An anonymous link was emailed to all program directors (PDs), while PDs and program coordinators (PCs) were asked to help distribute the survey to current fellows. Results: 17 PDs and 11 fellows completed the survey. The most common areas where little to no training was reported to be provided were: role of lung transplantation in patients with pulmonary arterial hypertension (68%), pathophysiology of cardiac dysfunction associated with portal hypertension (61%), and conditions that may impact mechanical circulatory support strategies in adult patients with congenital heart disease (58%). Respondents most requested a moderate to a significant amount of more training in the following areas: appropriate treatment of patients with each type of pulmonary hypertension (63%), pharmacology of medications available to treat pulmonary arterial hypertension (58%), and role of lung transplantation in patients with pulmonary arterial hypertension (53%). (The information reported is as of June 12, 2022. Data collection is ongoing.) Conclusions: Common gaps in curriculum delivery among US AHFTC fellowship programs appear to exist. The most desired area for additional instruction involves different aspects of the management of pulmonary hypertension. A focused centralized curriculum could be developed to teach these concepts, thereby better preparing AHFTC fellows to care for these types of patients in the future.

LIFELONG LEARNING INSTITUTE: MODULE 19: RELEVANT CLINICAL UPDATES FOR CHILD AND ADOLESCENT PSYCHIATRISTS

Maintaining competence in patient care, medical knowledge, and other core competencies is a requirement for all practicing child and adolescent psychiatrists. This annual Institute sponsored by the Lifelong Learning (LLL) Committee aims to provide a review of the literature from the past year covering a breadth of topics that every practicing child and adolescent psychiatrist should know.

Developing the Next Iteration of Radiation Oncology Milestones: How to Make Assessment More Useful for Both Residents and Faculty

Purpose Radiation Oncology Milestones 1.0 was developed in 2011 using the Accreditation Council of Graduate Medical Education's (ACGME) 6 core competencies to standardize the competency-based assessment of radiation oncology medical residents conducted by Clinical Competency Committees biannually. Critiques of Milestones 1.0 included the lack of clear progression between levels of the subcompetencies, and the complex language made it difficult to interpret by residents and faculty. The development of Milestones 2.0 aimed to simplify the language, clarify the expected progression of residents' competence, and provide supplemental resources for implementation. Methods The ACGME assembled a 9-member working group (academic radiation oncologists, residents, community members) to compose Milestones 2.0 for Radiation Oncology using a modified Delphi method consisting of multiple asynchronous small-group meetings interspersed with four web-based whole-group meetings until consensus was reached for each competency. Results Milestones 2.0 replaced disease-specific Patient Care subcompetencies (e.g., Lymphoma, Genitourinary) with those that emphasize the care delivery pathway (e.g., Consult, Simulation, Contouring and Target Delineation, Treatment Planning and Plan Evaluation, Treatment Delivery, Follow-up), restructured the Medical Knowledge competency, revised all subcompetency descriptions to chart a clear progression between levels, removed research from level 5 criteria, and provided a supplemental guide to aid implementation. Patient Care subcompetencies in Milestones 1.0 limited direct assessment of residents to specific rotations while revised subcompetencies in Milestones 2.0 can be assessed on every rotation. Level 5 in each subcompetency now reflects skills exhibited by the top 10% of residents and includes items such as "leads the multidisciplinary care team" under Consult. Previously, Medical Knowledge was an assessment of Medical Physics and Radiation/Cancer Biology. This has been modified to include Applied Sciences and Evidence-Based Foundations of Radiation Oncology with specific constructs to guide assessment. The supplemental guide gives real-life examples for each level within the subcompetencies to promote consistency in the implementation of Milestones 2.0 across residencies. The guide is designed as a living document to be tailored by programs to align with individual practices and allow for a shared mental model for faculty expectations. Discussion Milestones 2.0 builds on the foundation laid by Milestones 1.0 by aligning subcompetencies with clinical practice and represents a comprehensive approach to assessing core competencies necessary to succeed as a competent clinical radiation oncologist. The new framework will be put into practice in July 2022. Real-time feedback and additions to the supplemental guide will continue to refine and improve assessment of radiation oncology residents' clinical competence. Radiation Oncology Milestones 1.0 was developed in 2011 using the Accreditation Council of Graduate Medical Education's (ACGME) 6 core competencies to standardize the competency-based assessment of radiation oncology medical residents conducted by Clinical Competency Committees biannually. Critiques of Milestones 1.0 included the lack of clear progression between levels of the subcompetencies, and the complex language made it difficult to interpret by residents and faculty. The development of Milestones 2.0 aimed to simplify the language, clarify the expected progression of residents' competence, and provide supplemental resources for implementation. The ACGME assembled a 9-member working group (academic radiation oncologists, residents, community members) to compose Milestones 2.0 for Radiation Oncology using a modified Delphi method consisting of multiple asynchronous small-group meetings interspersed with four web-based whole-group meetings until consensus was reached for each competency. Milestones 2.0 replaced disease-specific Patient Care subcompetencies (e.g., Lymphoma, Genitourinary) with those that emphasize the care delivery pathway (e.g., Consult, Simulation, Contouring and Target Delineation, Treatment Planning and Plan Evaluation, Treatment Delivery, Follow-up), restructured the Medical Knowledge competency, revised all subcompetency descriptions to chart a clear progression between levels, removed research from level 5 criteria, and provided a supplemental guide to aid implementation. Patient Care subcompetencies in Milestones 1.0 limited direct assessment of residents to specific rotations while revised subcompetencies in Milestones 2.0 can be assessed on every rotation. Level 5 in each subcompetency now reflects skills exhibited by the top 10% of residents and includes items such as "leads the multidisciplinary care team" under Consult. Previously, Medical Knowledge was an assessment of Medical Physics and Radiation/Cancer Biology. This has been modified to include Applied Sciences and Evidence-Based Foundations of Radiation Oncology with specific constructs to guide assessment. The supplemental guide gives real-life examples for each level within the subcompetencies to promote consistency in the implementation of Milestones 2.0 across residencies. The guide is designed as a living document to be tailored by programs to align with individual practices and allow for a shared mental model for faculty expectations. Milestones 2.0 builds on the foundation laid by Milestones 1.0 by aligning subcompetencies with clinical practice and represents a comprehensive approach to assessing core competencies necessary to succeed as a competent clinical radiation oncologist. The new framework will be put into practice in July 2022. Real-time feedback and additions to the supplemental guide will continue to refine and improve assessment of radiation oncology residents' clinical competence.

Viewpoint on Milestones for Fellowship Training in Movement Disorders.

Viewpoint on Milestones for Fellowship Training in Movement Disorders.

Remote surgical education using synthetic models combined with an augmented reality headset

ObjectiveThe objective was to investigate the use of an augmented reality headset to remotely train clinicians on medical devices using anatomic models. DesignDisease-specific phantoms were developed to train physicians in mpMRI-guided fusion prostate biopsy, brachytherapy, and rectal spacer insertion. Training was remotely demonstrated using 1-way virtual video conferencing format. Participants responded to an educational content survey. A heads-up display with software and augmented reality was used for remote 2-way training with the proctor and student using on their own phantoms. SettingThe virtual video meeting took place during a prostate cancer conference in 2020, while the augmented reality training occurred in 2021. The proctor and student wore a heads-up display containing a projector and webcam where the ultrasound image was displayed onto a see-through optic along with the physician's hands. The heads-up display allowed the proctor to teach by line-of-sight while the student watched and repeated the steps. ParticipantsFaculty with expertise with the medical devices used in these procedures provided training to urologists unfamiliar with these techniques. ResultsParticipants responded that the 1-way training on the phantoms was realistic and mimicked human tissue. A total of 70.9% requested more training or training on the phantoms. The remote training platform was successfully beta tested at the 2 locations in transperineal prostate biopsy and rectal spacer insertion. ConclusionRemote training using augmented reality eliminates the need for travel. For training programs and workshops, this technology may mitigate the risk of infectious exposures, reduce training cost, and increase proctor availability, allowing training from their own institution or clinic.This investigation qualifies for the Accreditation Council for Graduate Medical Education competency in medical knowledge.

Developing Telemedicine Curriculum Competencies for Graduate Medical Education: Outcomes of a Modified Delphi Process.

Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education. A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended. Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies. Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.

Career Readiness Identified as Unmet Need in Fellowship Training

A gap analysis of Allergy & Immunology fellowship education at Children’s Hospital Colorado identified career readiness, specifically how to best select a job in line with their interests and how to market themselves as a competitive applicant, to be a more pressing unmet need than perceived deficits in medical knowledge or procedural competency.

Advancing Fellowship Training in Selective Pathology.

Program requirements for Selective Pathology fellowships in the United States were established by the Accreditation Council for Graduate Medical Education (ACGME) in 2011 to govern fellowships providing advanced training in surgical pathology, focused anatomic pathology, or focused clinical pathology. Selective Pathology entered the ACGME's Next Accreditation System in 2015 with the introduction of the Selective Pathology Milestones 1.0, a set of benchmarks for evaluating fellow progress in each of the 6 ACGME core competencies. In 2019, the ACGME convened a work group for a planned periodic update to these milestones. To summarize changes to the Selective Pathology milestones. The study design featured expert opinion and survey. The Patient Care milestones for anatomic pathology-focused fellowships contain a renewed emphasis on both gross and microscopic examination, whereas for clinical pathology-focused fellowships, the emphasis is on interpretation of laboratory assays. The milestones for the non-Patient Care, non-Medical Knowledge competencies have been updated to a harmonized set of milestones designed to extend across all specialties and subspecialties. New to the milestones program is a supplemental guide that provides examples, suggested assessment tools, and references to aid in implementation. Public comments were supportive of the changes. The Milestones 2.0 are set for implementation in July 2021. Updates in the new milestones are aimed at facilitating training and harmonizing evaluation across subspecialties.

A Validity Framework for Effective Analysis and Interpretation of Milestones Data.

A Validity Framework for Effective Analysis and Interpretation of Milestones Data.

Radiology residency training in China: results from the first retrospective nationwide survey

ObjectivesThis was the first study to systematically landscape and examine China’s nationwide standardized residency training in radiology.MethodsIn this retrospective cross-sectional study, we used data from the 2019 national survey of the first two cohorts of 3679 radiology residents who completed training in 2017 and 2018 across all 31 provinces in China. A total of 1163 (32%) residents participated in the survey. Multivariable logistic regression was used to examine the implementation frequency of 24 identified training tasks (categorized into six competencies) by region, demographics, and other residency information.ResultsAmong the 1163 respondents, 592 (51%) were trained in the more developed eastern region. Of the 24 identified training tasks, 15 were implemented significantly differently across regions, while the frequency of the most frequently conducted tasks (e.g., CT, MR, and radiograph interpretation and reporting) was consistent. The top 10 tasks all fell into the patient care and medical knowledge competency domains, while other competencies tended to be neglected. We found region and marital status were the most influential factors of training task implementation frequencies. Respondents trained in the northeast and the west were more likely to report, for instance, radiological examination recommendation (OR = 1.91, 95%CI = 1.27–2.88), as “very frequent.” Married respondents were more likely to report first-line night shift as “very frequent” (OR = 1.71, 95%CI = 1.29–2.26).ConclusionsDespite the fast-win achievements of developing a national radiology residency training program, there is a gap to train quality and homogeneous radiologists across regions. Future improvement should be more tailored to residents’ personal characteristics and emphasize some “soft” competencies (e.g., communication skills).

Development of a National Academic Boot Camp to Improve Fellowship Readiness.

Background: Pulmonary and critical care medicine (PCCM) fellowship requires a high degree of medical knowledge and procedural competency. Gaps in fellowship readiness can result in significant trainee anxiety related to starting fellowship training.Objective: To improve fellowship readiness and alleviate anxiety for PCCM-bound trainees by improving confidence in procedural skills and cognitive domains.Methods: Medical educators within the American Thoracic Society developed a national resident boot camp (RBC) to provide an immersive, experiential training program for physicians entering PCCM fellowships. The RBC curriculum is a 2-day course designed to build procedural skills, medical knowledge, and clinical confidence through high-fidelity simulation and active learning methodology. Separate programs for adult and pediatric providers run concurrently to provide unique training objectives targeted to their learners’ needs. Trainee assessments include multiple-choice pre- and post-RBC knowledge tests and confidence assessments, which are scored on a four-point Likert scale, for specific PCCM-related procedural and cognitive skills. Learners also evaluate course material and educator effectiveness, which guide modifications of future RBC programs and provide feedback for individual educators, respectively.Results: The American Thoracic Society RBC was implemented in 2014 and has grown annually to include 132 trainees and more than 100 faculty members. Mean knowledge test scores for participants in the 2019 RBC adult program increased from 55% (±14% SD) on the pretest to 72% (±11% SD; P < 0.001) after RBC completion. Similarly, mean pretest scores for pediatric course attendees increased from 54% (±13% SD) to 62% (±19% SD; P = 0.17). Specific content domains that improved by 10% or more between pre- and posttests included airway management, bronchoscopy, pulmonary function testing, and code management for adult course participants, and airway management, pulmonary function testing, and extracorporeal membrane oxygenation for pediatric course participants. Trainee confidence also significantly improved across all procedural and cognitive domains for adult trainees and in 10 of 11 domains for pediatric course attendees. Course content for the 2019 RBC was overwhelmingly rated as “on target” for the level of learner, with <4% of respondents indicating any specific session was “much too basic” or “much too advanced.”Conclusion: RBC participation improved PCCM-bound trainee knowledge, procedural familiarity, and confidence. Refinement of the RBC curriculum over the past 7 years has been guided by educator and course evaluations, with the ongoing goal of meeting the evolving educational needs of rising PCCM trainees.

"What Do You Want to Learn or Work on Today?": Benefits and Barriers to Asking Residents for Self-identified Learning Goals.

In the emergency department (ED), residents and attendings may have a short-term relationship, such as a single shift. This poses challenges to learner assessment, instructional strategy selection, and provision of substantive feedback. We implemented a process for residents to identify goals for ED shifts; characterized residents' goals; and determined how goal identification affected learning, teaching, and feedback. This was an observational study in a large, tertiary pediatric ED using mixed methods. Residents were asked to identify learning goals for each shift and were asked postshift if they had identified, accomplished, and/or received feedback on these goals. Goals were categorized by Accreditation Council for Graduate Medical Education Core Competencies. Predictors of goal identification, accomplishment, and receipt of feedback were determined. Residents and attendings were interviewed about their experiences. We collected 306 end-of-shift surveys (74% response rate) and 358 goals and conducted 29 interviews. We found that: 1) Goal setting facilitated perceived learning. Residents identified goals 54% of the time. They accomplished 89% of and received feedback on 76% of goals. 2) Residents' perceived weaknesses, future practice settings, and available patients informed their goals. Most goals mapped to patient care (59%) or medical knowledge (37%) competencies. 3) Goal identification helped attendings determine residents' needs. 4) Ideal goals were specific and achievable. 5) Common barriers were busyness of the ED and difficulty creating goals. Residents were less likely to identify goals (odds ratio [OR]= 0.62, 95% confidence interval [CI]= 0.41 to 0.94) and receive feedback on busy evening shifts (OR= 0.19, 95% CI=0.10 to 0.37) and were most likely to receive feedback overnight (OR= 3.66, 95% CI= 1.87 to 7.14). Asking residents to identify goals for ED shifts as an instructional strategy facilitated perceived learning, goal accomplishment, and receipt of feedback. Resident-driven goal identification is a simple and effective instructional strategy that physicians can incorporate into their precepting in the ED.